Page 209 - The Netter Collection of Medical Illustrations - Integumentary System_ Volume 4 ( PDFDrive )

Plate 6-34 Infectious Diseases

CONDYLOMATA ACUMINATA (GENITAL WARTS)

In females
“Cauliflower”-appearing plaques

VERRUCAE (WARTS) (Continued)

infrequently encountered, and a high clinical suspicion
should be used when investigating these types of warts.
Ring warts are seen after various treatments of
common warts, most frequently after liquid nitrogen
therapy. The central portion of the wart resolves,
leaving a ring-shaped or donut-shaped wart with central
clearing. These warts can become larger than the wart
originally treated.
Condylomata acuminata (genital warts) are often Cervical HPV infection
considered to be the most common form of sexually is the leading cause of
transmitted disease in the United States. These warts cervical cancer.
typically begin as small, flesh-colored to slightly hyper-
pigmented macules and papules. As they grow, they take
on an exophytic growth pattern and have often been
compared with the appearance of cauliflower. The
warts may stay small and localized, or they may grow to
enormous size, leading to difficulty with urination and
sexual intercourse. Females with cervical genital warts
are asymptomatic and may not realize they are infected.
Routine gynecological examinations and Papanicolaou
smears are the only reliable way to diagnosis cervical
warts. Diagnosis is extremely important, because cervi-
cal warts are the number one cause of cervical cancer.
Histology: Skin biopsies of wart tissue show the
pathognomonic cell called the koilocyte. This cell, In males
when present, is highly specific and sensitive for HPV HPV is one of the most common
infection. It is a keratinocyte with a basophilic small sexually transmitted diseases.
nucleus and a surrounding clear halo. There are few to
no keratohyalin granules in the koilocyte. Other find-
ings include varying amounts of hyperkeratosis, acan-
thosis, and striking papillomatosis.
Pathogenesis: Warts are caused by infection with
HPV, of which more than 150 subtypes are known to
cause human disease. They are small viruses with no
lipid envelope, and they can stay viable for long periods.
HPV has a double-stranded, circular DNA. A variety
of subtypes are able to affect different regions of the
body. HPV is capable of infecting human epithelium,
including the keratinized skin and the mucous mem-
branes. It gains entry through slightly abraded skin or
mucous membranes. The virus does not actively infect
the outer stratum corneum but rather the stratum
basalis cells. Like most viruses, HPV can produce early
and late gene products. The early genes encode various spontaneously resolve. The others may or may not therapy appears to work better than any other, and
proteins necessary for replication. These early gene respond to therapy. This lack of universal treatment patients often need to undergo a variety of treatments
products also play a role in malignant transformation response is frustrating to patient and physician alike. until they find one that works.
of the infected cell. The exact mechanism is not com- Many destructive therapies are available, including Genital warts should be treated with imiquimod or
pletely understood. The late genes produce capsid pro- liquid nitrogen cryotherapy, salicylic acid, trichloracetic one of the destructive methods to decrease the risk of
teins. At least eight early genes are present, and two late acid, cantharidin, podophyllin, and bleomycin. Immu- transmission. Women who are sexually active should
genes are included in the viral DNA. notherapy can be used to induce an immunological undergo routine gynecological screening. The advent
Treatment: Common warts can be treated in a response; these options include imiquimod, interferon, of the HPV vaccine may lead to a decreased incidence
number of ways. Approximately 50% of the lesions squaric acid, and Candida skin test antigen. No single of genital warts and cervical cancer.

THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS 195